What’s the difference between ASD and AuDHD?

I just want to say that ADHD medication has been life changing for my ASD son. He can now enjoy a conversation, tolerate queues, go on holiday and listen in class. I have seen no negatives at all from the medication and my son really notices all the positives.

I think it’s very likely that there is no clear distinction at all between ASD and ADHD. That’s often how things go with diagnoses of mental conditions. A lot of people now believe that schizophrenia and manic depression are the same thing. The way the lines are drawn are very arbitrary and change hugely over time. These are not fixed conditions existing independently of time and place. Barely anyone with an ASD diagnosis would have met the criteria for diagnosis as it was in the 1970s, for example.

Following with interest.

I suspect we will have the exact same issue with DS1 down the line. Diagnosed autistic, dyspraxic, high IQ and demand avoidant at 4.

In comfortable environments he is hyperactive, impulsive, overtly emotional and has a very low frustration tolerance. Can’t cope with being on his own at all. Needs tons of novelty and stimulation. School only see a tiny fraction of what we do and feel it is all due to sensory issues associated with ASD.

The ASD traits are subtle. His speech is phenomenal and, maybe classically for PDA profile, he is surface level sociable. Stimming is subtle. His need for routine and predictability is subtle, especially given his surface level love of novelty. Family friends were shocked when he was referred and a lot don’t believe it.

I think the difference in home and school will mean we never get referred, which is a shame as I would like a formal assessment.

I don’t want to derail the thread, but oh lord, I relate to your last paragraph so much!!
‘crave routine and sameness while also needing dopamine and excitement’ and the brain that never shuts up!!!

I am newly diagnosed ADHd with autistic traits (I couldn’t face pushing for both at the same time, so thought I would focus on adhd diagnosis first …)

I honestly don't understand how anyone who is autistic isn't ADHD.

How could an assessment possibly distinguish between:

• autistic inertia and being inattentive due to ADD

Or

• hyper focus due to ADHD and special interest due to being autistic

Or

• stimming due to sensory needs due to being autistic and stimming due to hyperactivity in ADHD

Also I believe executive functions difficulties and poor working memory can be due to any Neurodivergent diagnosis.

Yes it really is so awful. Even now, when I know in my head there's a reason for it, I can't stop or control it.

@SalsaLights "I can be very impulsive but also have a fear of rule-breaking. When the impulsiveness 'wins' this is followed by huge anxiety and catastrophising about having broken the rules, which then manifests physically in not being able to sleep or settle, upset stomach and so on."

This could also very much describe by AuDHD DH, especially in his twenties. He'd drink to excess, do something impulsive and then fret about it for days afterwards. I know the latter isn't uncommon for young men but the anxiety afterwards was horrific.

My DH is AuDHD. Our DS4 is diagnosed with ASD and I strongly suspect ADHD too, but we've been told we have to wait until he is 6 to explore that because the behaviours are so hard to separate at a young age.

I'm not in my DHs head obviously but my take is always that while he has the rigidity of thought you'd expect in someone with ASD, he's in many ways utterly chaotic and resistant to routine in daily life in ways that aren't usually associated with autism. The idea of things having a place is foreign, he loses everything, he forgets instructions two seconds after they are given, he has no idea how long any task takes, for the longest time he didn't cook a recipe with more than three steps because it just overwhelmed him. I'm making him sound like he barely functions but he's a super successful professional because he hyper focuses on work and expends almost all his executive functioning ability on that.

The conflict between the two can be pretty miserable. I was diagnosed with ADHD last year. Currently in the latter stages of ASD review on the recommendation of the psychiatrist I saw for my ADHD assessment.

I can be very impulsive but also have a fear of rule-breaking. When the impulsiveness 'wins' this is followed by huge anxiety and catastrophising about having broken the rules, which then manifests physically in not being able to sleep or settle, upset stomach and so on.

I struggle in busy social situations as I find them overwhelming and very stressful. I am not good at small talk although people say I am friendly and chatty. The effort it takes to try and 'be normal' is huge. I tend to go home early as more than a couple of hours and it becomes too much. But I will impulsively agree to go to things and then regret doing so

I get bored very easily and have the attention span of a goldfish, unless it's something that I feel is worth spending time on, at which point I'll be immersed in it even if the house is burning down. I'm a champion procrastinator, but fear of missing a deadline or not doing something right means I'll leave it to the last minute, and then work all night to get it done.

I have routines that I stick to because they are comforting - re-watching and re-reading things I have already seen because I like the familiarity. I go through food obsessions where I'll eat the same thing for days on end, but there are certain things I can't cope with. I won't touch mashed potato that I haven't made myself or that isn't from a supermarket, because even the tiniest hint of graininess or minute lumps, makes me feel ill. All of my socks are identical because I finally found some seamless ones and that I like, and I have to cut the labels out of clothes because I can't wear them otherwise.

All of the above has become much easier for me to deal with now I know the reason why, and meds have also helped. I feel a lot happier now that I have an explanation, having spent my whole adult life wondering why I feel so unhappy and the odd one out all the time. My work is very structured which helps me feel more organised, and I have similar routines at home which have helped.

My 13 year old has been medicated for over 6 mths now and it has made a massive difference tonher levels of aggression, mindfulness and awareness. From a parent whose child was in burnout from bullying at 2 mainstream and could abs not control her outbursts.

I haven’t read all. Upwards of 50 percent of autistic individuals also have ADHD there is an overlap but there is also a co-occurrence. 20 years ago you could not diagnose both so there is still an element of over attributing features of ADHD to autism. Autistic people are often more sensitive to meds but there are options that can work and support if that is indicated.

That is such a helpful post. Thank you so much @TheWayTheLightFalls . I'm amazed never to have heard of this issue before and it would be so relevant to DS. I appreciate your reply a lot.

It’s worth getting on to somewhere like reddit and looking up “audhd dexamphetamine” or the equivalent trade name, like Elvanse. People have a wide range of experiences. Broadly my experience mirrored a lot of others’ - the medication heightened my senses, even at a low dose (autistic people can tend to be more sensitive to medication). So all the lights felt brighter, noise felt louder, clothes felt itchier and the dry mouth side effect, which is very common, made my mouth feel like sandpaper. Many autistic people are sensitive to some of the above anyway under normal conditions - having your senses cranked right up is very unwelcome. Lord knows if the medication improved my ability to concentrate - I was too overwhelmed with the above. I also simply felt more autistic - like the ADHD side of me which makes me friendly and able to chat and be a bit spontaneous was severed suddenly, and I was left with just the autistic side.

There are other ADHD medications - second line, third line, subsequent ones which specialist psychiatrists can prescribe. But my experience put me off to the extent that I am not willing to try them.

They are different but often overlap.

Autism can be:

Social communication Issues
Language issues
Inflexible thinking

Adhd is executive function issues: concentration, focus, procrastination, interrupting etc

Not sure I agree with the 'adhd needs to be in 2 settings'. I have both (Autism isn't diagnosed) and adhd symptoms weren't really present at school, except I would fidget with my legs under the table.

Thank you for this post. I had no idea that ADHD meds were terrible for autistic brains. DS2 has a diagnosis of autism but has so many ADHD traits that are similar to mine. (I got a late adulthood diagnosis and meds have changed my life.) I was hoping he could start on ADHD meds too but not if they might wreak havoc. Would you mind saying more about how they are incompatible?

I do know a few people who have been diagnosed with audhd.

There doesn't seem a huge difference in presentation, but I would say they seemed more social and that the adhd seems more noticeable than the autism in these people.

But they thing I have noticed that when they take adhd meds, the autism really shows after. So the communication issues restricted behaviour become more visible.

I agree it's really unclear.

At school I struggled to concentrate too. I needed to rock on my chair or doodle at the same time. I have sensory sensitivities and was socially anxious. It wouldn't be obvious from looking at me why I was struggling to concentrate, but I can tell you it was nothing to do with anxiety or sensory stuff.

I was a) bored because the work was too easy, and b) I can only concentrate on verbal info if I can doodle or move around in some way, otherwise it feels unbearable, which I now understand as part of my ADHD. The sensory stuff for me is more things like supermarket lighting/clothing, and the anxiety would only affect me doing group work, at break time, or speaking in front of the class.

If you've got a kid like my DD who is bright and seems articulate, but struggles to recognise or express her feelings, all you might get is "I can't concentrate". With other kids it might just be adults observing that they can't concentrate well. It's such a challenge to unpick it all.

My dd was first assessed for ADHD as that's what she scored more higher on, on the forms we were given. Though I felt her 'symptoms' were more ASC relatable.

At her ADHD assessment we got told no ADHD and would refer for ASC diagnosis, at ASC assessment she was diagnosed as ASC and ADHD, which shocked us.

All counties do it differently unfortunately as it is based on their practice and the practioneers pov, I think it helped when we got her diagnosis when dd was now 11, (had started the process 4 years earlier) so more history to write about, more observations to note and also dd could give her side. And her AuDHD doesn't impact her daily too much so having a delayed diagnosis wasn't too detrimental.

There is a massive overlap between the 2 and more and more children are being diagnosed as AuDHD. Though my dd adhd is the inattentive side than hyperactive!

The system in general is shocking, I know of adults being messed around getting a combined diagnosis- as they were diagnosed ADHD as kids!

I have both so I can tell the difference, so it probably is a bit harder with a small child but the professionals should be trained to see the subtle differences. One sign of adhd from my assessment was loosing things frequently I don't think that is on any asd list. Neither Is disorganisation

I find the info graphics very confusing though. They all seem to differ slightly and plenty of the 'only adhd' traits can be explained away by autistic behaviours - e.g. lack of focus = adhd trait but autism can cause lack of focus due to sensory issue, dysregulation, trying to concentrate on something when there are multiple things going on at once. I'm autistic and do not have adhd and I struggled with concentration at school because I found things like the classroom lights and the brightly coloured display boards too distracting (sensory). It is very hard to unpick which traits are autistic and which could be adhd. When you are trying to figure this out with a child who already struggles with communication, it seems like an impossible task.

DS got an autism diagnosis first, then ADHD. We were told similar at the autism assessment - that the ADHD traits could be explained by the autism diagnosis. However, it was an online assessment during COVID, and they barely interacted with him. We ended up getting him assessed for ADHD too a couple of years later. He clearly has ADHD too (as agreed by assessors, teachers, and everyone we know!)

Given that a large proportion of autistic people also have ADHD, and as assessments have such long waiting lists/are expensive, surely it would make sense to assess for both at the same time...